Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
We were discussing fever. Let me now deal with some other
common myths concerning this common problem. As discussed
before, fever is often an early sign, so often we must just
wait to see what will become of it. Height of fever is not
important, but rather how does the child look? The best test
in my opinion is seeing how the child eats. Lethargy may be
due to a severe infection or dehydration, but it always needs
us to take it seriously. A happy child playing well with a
fever of 41 is OK with close observation.
Another myth is that high fever is dangerous. It is
dangerous, but we are talking about runaway high fevers above
42. Kids will feel better with lower temperatures and may
return to themselves, but a kid who is doing fine with a
temperature does not need to have it reduced. Fever may even
be beneficial.
If you do need to reduce fever, paracetamol and ibuprofen are
the best in my opinion. Aspirin does work fine, but it can
cause a devastating disease caused Reye's syndrome and
therefore is not used anymore.
Another myth: fever can be measured in the armpit. It is not
reliable, and neither are fever strips put on the forehead.
Ear thermometers are also not reliable. Rectal temperatures
are usually different from oral ones, but it isn't clear to
me which is more accurate. A child breathing heavily will
lower an oral temperature, while a child with a rectum full
of stool will also have a temperature that is not accurate.
Mercury thermometers are being phased out in the West. This
will be a problem for Shabbos observers.
Vaccinations are very important and have (almost) eliminated
some very serious diseases of the past. Nevertheless, they
can cause a fever. Teething -- no one is really sure. I doubt
that it is a major source of fever. It pays to check all
other sources first.
Another myth that drives me crazy is based on the fact that
many infections are viral. (Don't ask which virus. There are
more of them than there are people who ever roamed this
earth.) Usually they get better in a few days. Antibiotics do
not help these infections. Often I will tell a parent that
they do not need antibiotics at this point. After the fever
persists for one more day -- which is what happens with
viruses -- they go to another doctor who prescribes
antibiotics without a source of infection, and voila! The
child gets better in two days. The myth is that the child
would have gotten better in two days anyhow, but now the
patient believes that antibiotics were necessary.
Another myth: Antibiotics do not work so fast, and fever will
persist for another 24-48 hours. Also, changing antibiotics
after a full course is not usually indicated.
Urinary tract, pneumonia, strep throat are common infections.
Ears are trickier. We will discuss these and other rarer
sources of infection in our next column. Write me in care of
the Yated.
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